Observational study of newborn infant parasympathetic evaluation as a comfort system in awake patients admitted to a pediatric intensive care unit

  • Juan Valencia-RamosEmail author
  • Juan Arnaez
  • Sara Calvo
  • Fernando Gomez
  • Isabel Del Blanco
Original Research


To compare the newborn infant parasympathetic evaluation system (NIPE) scores with a validated clinical scale using two different nebulizers in children with bronchiolitis admitted to a PICU. Comfort was evaluated using the COMFORT-behavior scale (CBS) before (T1), during (T2) and after (T3) each nebulization. In order to compare NIPE and CBS values during the whole T1 to T3 period, the variable Dif-CBS was defined as the difference between maximal and minimal CBS scores, and Dif-NIPE as the difference between 75th and 25th percentile NIPE values. Analyses were carried out, firstly for the total of nebulizations and secondly comparing two different nebulization systems: a jet nebulizer (JN) and a nebulizer integrated in high flow nasal cannulas (NHF). 84 nebulizations were recorded on 14 patients with a median [25th–75th percentile] age of 6 months (3.1–9.5). A Dif-CBS of 4 points (2–7), as well as changes in CBS scores between T1 and T2, defined the nebulization as a discomfort stimulus. The NIPE system, represented as the Dif-NIPE, showed a median variation of 9 points (7–10), and was poorly correlated to Dif-CBS [rs 0.162 (P = 0.142)]. Discomfort during nebulization, assessed by CBS was greater with the JN system compared to NHF: 17 (13–22) vs 13 (9–15) (P = 0.001). NIPE monitoring detected no significant differences between both nebulization systems (P = 0.706). NIPE monitoring showed a variation in comfort during nebulization in the patient with bronchiolitis, though correlation with CBS was poor. Further research is required before NIPE can be suggested as a comfort monitoring system for the awake infant.


Comfort Newborn infant parasympathetic evaluation COMFORT Behavior Scale Nebulization Bronchiolitis 



We are grateful to MMDOLORIS for providing a NIPE monitor for this study.

Compliance with ethical standards

Conflict of interest

No conflicts of interest declared.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Pediatric Intensive Care UnitBurgos University HospitalBurgosSpain
  2. 2.Department of NeonatologyBurgos University HospitalBurgosSpain
  3. 3.Fundación NeNeMadridSpain
  4. 4.Research UnitBurgos University HospitalBurgosSpain

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